| Doctor Name: | MS. MARY ANN KELLY |
| NPI Number: | 1518187772 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.D. |
| License Number: | 709057 |
| Business Practice Address: | 63437 Quail Springs Road Joshua Tree, CA - 92252 |
| Business Phone Number: | 7603668390 |
| Business Fax Number: | 7604182243 |
| Mailing Address: | Po Box 1357, 63437 Quail Springs Road JOSHUA TREE |
| State: | CA |
| Postal Code: | 92252 |
| Phone Number: | 7603668390 |
| Fax Number: | 7604182243 |
| NPI Enumeration Date: | 04/27/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133VN1004X |
| License Number: | 709057 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | IL |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | Nutrition, Pediatric |
| Taxonomy Definition: | |